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Clinical detection of low upper body blood flow in very premature infants using blood pressure, capillary refill time, and central-peripheral temperature difference
  1. D A Osborn1,
  2. N Evans1,
  3. M Kluckow2
  1. 1Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
  2. 2Royal North Shore Hospital, University of Sydney
  1. Correspondence to:
    Dr Osborn
    Department of Neonatal Medicine, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia 2050;


Objective: To determine the accuracy of blood pressure (BP), capillary refill time (CRT), and central-peripheral temperature difference (CPTd) for detecting low upper body blood flow in the first day after birth.

Methods: A prospective, two centre cohort study of 128 infants born at < 30 weeks gestation. Invasive BP (n = 108), CRT (n = 128), and CPTd (n = 46) were performed immediately before echocardiographic measurement of superior vena cava (SVC) flow at three, 5–10, and 24 hours after birth.

Results: Forty four (34%) infants had low SVC flow (< 41 ml/kg/min) in the first day, 13/122 (11%) at three hours, 39/126 (31%) at 5–10 hours, and 4/119 (3%) at 24 hours. CPTd did not detect infants with low flows. Combining all observations in the first 24 hours, CRT ⩾ 3 seconds had 55% sensitivity and 81% specificity, mean BP < 30 mm Hg had 59% sensitivity and 77% specificity, and systolic BP < 40 mm Hg had 76% sensitivity and 68% specificity for detecting low SVC flow. Combining a mean BP < 30 mm Hg and/or central CRT ⩾ 3 seconds increases the sensitivity to 78%.

Conclusions: Low upper body blood flow is common in the first day after birth and strongly associated with peri/intraventricular haemorrhage. BP and CRT are imperfect bedside tests for detecting low blood flow in the first day after birth.

  • capillary refill time
  • central-peripheral temperature difference
  • hypotension
  • premature
  • echocardiography
  • BP, blood pressure
  • CPTd, central peripheral temperature difference
  • CRT, capillary refill time
  • LR+, positive likelihood ratio
  • LR−, negative likelihood ratio
  • NPV, negative predictive value
  • P/IVH, peri/intraventricular haemorrhage
  • PPV, positive predictive value
  • ROC, receiver operator curve
  • SBF, systemic blood flow
  • Sn, sensitivity
  • Sp, specificity
  • SVC, superior vena cava

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  • Supported by the National Health and Medical Research Council of Australia and The North Shore Heart Research Foundation, Sydney, Australia.

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